Estimating the prevalence of dyspareunia according to mode of delivery: a systematic review and meta-analysis

Postpartum and Lactation-Related Genitourinary Symptoms: A Systematic Review

OBJECTIVE

To consolidate the best available evidence on the prevalence of genitourinary syndrome of lactation and its associated symptoms, including vaginal dryness, vaginal atrophy, urinary symptoms, dyspareunia, and sexual dysfunction, among postpartum lactating individuals.

METHODS

The systematic review adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. A comprehensive search of PubMed, Google Scholar, Scopus, ScienceDirect, and Cochrane Library databases was conducted through April 30, 2024. A search in ClinicalTrials.gov did not yield any studies. Search terms included combinations of "postpartum lactation" or "breastfeeding" and "genitourinary symptoms." Eligibility was limited to studies on postpartum individuals assigned female at birth without congenital vulvar abnormalities that were written in English. Studies on participants taking exogenous hormone therapy or with diagnosed hormonal disorders were excluded. Screening involved two independent reviewers, with conflicts resolved by a third reviewer. Data were analyzed with R software. Study quality was assessed with the Oxford Centre for Evidence-Based Medicine Levels of Evidence and the JBI Critical Appraisal Checklist.

RESULTS

Of 1,550 studies initially screened, 65 met inclusion criteria. Among postpartum lactating individuals, the prevalence of vaginal atrophy and dryness was 63.9% (95% CI, 55.3-71.6%) and 53.6% (95% CI, 33.6-72.5%), respectively. Meta-analyses for dyspareunia at 3, 6, and 12 months postpartum revealed pooled prevalence estimates to be 60.0% (95% CI, 45.1-73.3%), 39.7% (95% CI, 28.9-51.5%), and 28.5% (95% CI, 26.3-30.9%) and pooled odds ratios to be 2.33 (95% CI, 1.92-2.83), 2.24 (95% CI, 1.62-3.10), and 1.45 (95% CI, 1.36-1.56) compared with women of reproductive age who were not postpartum, respectively. The pooled prevalence for sexual dysfunction was 73.5% (95% CI, 59.1-84.2%) and mean FSFI (Female Sexual Function Index) score was 21.5±1.83 (threshold for sexual dysfunction less than 26.55).

CONCLUSION

This systematic review highlights the significant effect of lactation-induced hormone deficiency on genitourinary health, with the majority reporting vaginal atrophy and dryness and a high proportion also experiencing sexual dysfunction.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, CRD42024519600.

The severity of second-degree perineal tears and dyspareunia during one year postpartum: A prospective cohort study

INTRODUCTION

Childbirth-related injuries of the pelvic floor may impact women's sexual health with symptoms such as dyspareunia. A better understanding of dyspareunia based on tissue trauma severity in second-degree tears is needed. The primary aim of this study was to assess differences in dyspareunia according to the severity of perineal tears, with a focus on subcategories of second-degree tears at three and twelve months postpartum. The secondary aim was to assess the time to resumption of intercourse after birth according to the severity of second-degree tears.

MATERIAL AND METHODS

This single-center observational cohort study was conducted between January 2021 and July 2022. Women meeting the inclusion criteria were included during pregnancy. After birth, all perineal tears were classified according to RCOG recommendation, and second-degree tears were further subcategorized based on the percentage of damage to the perineum (2A, 2B, 2C). Dyspareunia and time to resumption of intercourse were collected through an electronic questionnaire at three and twelve months postpartum.

RESULTS

Our study included 857 women; of them, 51.6% (n = 442) were primipara and 48.4% (n = 415) were multipara. The percentages of women reporting dyspareunia according to the degree of the tear at three months postpartum were as follows: no tear/first-degree tear 60%, 2A-tear 60%, 2B-tear 52%, 2C-tear 77%, and episiotomy 77%; and at twelve months postpartum: no tear/first-degree tear 52%, 2A-tear 50%, 2B-tear 40%, 2C-tear 69%, and episiotomy 64%. When comparing dyspareunia between the no tear/first-degree tear category and the second-degree subcategories, no statistically significant differences were found. Women in all second-degree subcategories resumed intercourse approximately 4.8 months postpartum, compared to 3.8 months postpartum for those with no tear or first-degree tear (p < 0.05).

CONCLUSIONS

There was no statistically significant association between the severity of second-degree tears and dyspareunia. The proportion of women reporting dyspareunia is noticeable for all perineal tear categories, with the highest rate among women with the most severe second-degree perineal tear. Women in all second-degree subcategories resumed intercourse approximately one month later than those with no tear or first-degree tear.

Resumption of sexual activity after childbirth and its related factors in Spanish women, a cross-sectional study

The resumption of sexual activity (RSA) after childbirth is problematic for many women; however, it is rarely addressed as a whole in consultation with a midwife.

OBJECTIVE

to describe the sexual function of women in the postpartum period and its relationship with their personal characteristics. To make a proposal adapted to their needs in conjunction with a midwife.

METHOD

a descriptive cross-sectional study carried out within the Basque Health Service. 281 postpartum women were recruited by a midwife in hospital, in primary care or through peer information, and answered a digital questionnaire about RSA with ten questions about desire, arousal, lubrication, orgasm, satisfaction, pain and knowledge and attitude about contraception. The predictor variables were type of delivery, perineal injury, breastfeeding, self-image and partner affection. Age, parity and educational level were taken into consideration. A descriptive analysis of each variable was carried out and multiple linear regression models were built for each domain.

RESULTS

25.73 % of the total had resumed sexual relations, and 49.5 % of those who responded 6 weeks after giving birth had not yet done so. Satisfaction scored 3.52 (maximum 5). Genital injuries (β=-0.23, 95 %CI:-1.54, -0.07, p = 0.003), breastfeeding (β=-0.34, 95 %CI: -4.8, -1.18, p = 0.002), emotional support (β = 0.33, 95 %CI: 1.1, 4.69, p = 0.002) and self-image (β =-0.23, 95 % CI: -1.2,-0.07, p = 0.003) influenced at least three domains of sexual function.

DISCUSSION

Postpartum care should include an expert response about physical state and an interview with the couple that addresses changes, self-image and emotional support.

Sexual conflict over sex-an underappreciated consequence of childbirth?

Many postpartum women experience sexual dysfunction, characterised by reduced sexual motivation and libido, and pain during intercourse. Menstruation is also suppressed in breastfeeding women (lactational amenorrhoea). Lactational amenorrhoea has been discussed in an evolutionary context due to its positive impacts on birth spacing. In contrast, postpartum sexual dysfunction has not been viewed through an evolutionary lens. Might postpartum sexual dysfunction also be under selection? We discuss possible evolutionary explanations for postpartum sexual dysfunction. In particular, we suggest that sexual conflict, a widespread phenomenon that occurs when the evolutionary interests of males and females diverge, may be a cause of disrupted postpartum sex. This sexual conflict-based explanation generates predictions relevant to the health and well-being of new mothers that warrant testing.

Postpartum care: Clinical considerations for improving genital and sexual health

The postpartum period encompasses the biological and psychoaffective transition to motherhood. However, it remains a most neglected phase in a woman's life. Furthermore, the transition to parenthood is a critical and potentially disrupting factor in a couple's relationship, which can be complicated by undiagnosed biological and psychosexual difficulties. Lack of recognition of the many biological and medical factors that can affect women's health and sexuality in the postpartum period is a common and persistent clinical omission worldwide. Communication difficulties exist between healthcare professionals and women and there are wording biases in describing female genitalia. This can further contribute to the diagnostic lack of attention and timely diagnosis and treatment of even very bothersome symptoms. Early diagnosis and treatment of common postpartum conditions is vital and quality care for new mothers should include psychological and emotional support, lactation assistance, early diagnosis and treatment of genital and sexual pain symptoms, pelvic floor rehabilitation and sexual health guidance. The inclusion of correct genital hygiene practices is a critical element of postpartum gynaecological counselling and can help improve overall genital and sexual health. In this review, we summarise the variability in global professional guidelines for postpartum care, identify common health problems faced by postpartum women and discuss appropriate postpartum care. We pay specific attention to prominent biological or medical factors that can impact the emotional and psychosexual wellbeing of women and couples. The aetiology, diagnosis and treatment of sexual dysfunction, in particular sexual pain disorders, is therefore discussed with a pragmatic approach. Finally, the role of intimate hygiene care is discussed with special attention given to cleanser ingredients with solid scientific evidence to help clinicians adopt a more tailored approach with their clinical recommendations.

Experiences of Dyspareunia in Dominican Women with a History of Sexual Abuse: A Phenomenological Study

INTRODUCTION

Dyspareunia refers to painful sexual intercourse that negatively affects a person's psychological well-being and quality of life and can also have an impact on their partner, family, and social circle. The objective of this study was to understand the experiences of women with dyspareunia and a history of sexual abuse in the Dominican Republic.

METHODS

This was a qualitative study based on Merleau-Ponty's hermeneutic phenomenology. Fifteen women with a diagnosis of dyspareunia and a history of sexual abuse participated. The study was carried out in Santo Domingo, Dominican Republic.

RESULTS

In-depth interviews were conducted for data collection. Through inductive analysis using ATLAS.ti, 3 main themes were developed that represent women's experiences of dyspareunia and sexual abuse: (1) a history of sexual abuse as a background to dyspareunia, (2) living in fear in a society that revictimizes the survivor, and (3) the sexual consequences of dyspareunia.

DISCUSSION

In some Dominican women, dyspareunia stems from their history of sexual abuse, which was unknown to their families and partners. The participants experienced dyspareunia in silence and found it difficult to seek help from health care professionals. In addition, their sexual health was marked by fear and physical pain. There are individual, cultural, and social factors that influence the occurrence of dyspareunia; a better understanding of these factors is vital for planning innovative preventive strategies that reduce the progression of sexual dysfunction and its impact on the quality of life of people with dyspareunia.